Throughout South America, indigenous communities are less economically prosperous and more vulnerable to many infectious diseases than are neighboring rural peasant communities. However, little is known about the extent to which variation in economic prosperity is accounted for by variation in the health status of adults across these rural communities of diverse ethnicity. The three-fold objective of the proposed project is to contribute to knowledge about associations between health and economic productivity, to measure the effects on health and economic productivity of community-based interventions that are designed to increase health-related stocks of human and social capital, and to integrate cost-effective components of community-based programs into the national and private health care systems of eastern Paraguay. More specifically, the present research seeks to: 1) test five hypotheses derived from a causal path model with adult health status as the predictor variable, economic productivity and various aspects of economic decision making as intermediate variables, and the well-being of household members as the outcome variable, 2) examine and control for the effects of specific components of ethnicity on causal variables in the path model, 3) determine to what extent variation in health status accounts for differences in economic prosperity between Ava, Ache and rural peasant communities located in the buffer zone of the Mbaracayu Reserve of eastern Paraguay, 4) design and implement programs, and measure cost effectiveness of interventions through partnerships with community members, and 5) involve the Ministry of Health in certification of health care workers trained by project staff, and in evaluations of interventions and existing programs that rely on health and economic outcome measures. To meet these objectives, an international collaborative team of Paraguayan and American scientists, health care and economic development professionals will oversee microlevel investigations in eight communities of Mbaracayu that include ecologic comparison (Yrs 1-2), longitudinal intervention and cost effectiveness studies (Yrs 3- 5).